Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Statistics, Modelling and Economics Department, Public Health England, London United Kingdom.
PLoS One. 2018 Nov 15;13(11):e0207183. doi: 10.1371/journal.pone.0207183. eCollection 2018.
To quantify inequalities in zoster vaccine uptake by determining its association with socio-demographic factors: age, gender, ethnicity, immigration status, deprivation (at Lower-layer Super Output Area-level), care home residence and living arrangements.
This population-based cohort study utilised anonymised primary care electronic health records from England (Clinical Practice Research Datalink) linked to deprivation and hospitalisation data. Data from 35,333 individuals from 277 general practices in England and eligible for zoster vaccination during the two-year period (2013-2015) after vaccine introduction were analysed. Logistic regression was used to obtain adjusted odds ratios (aOR) for the association of socio-demographic factors with zoster vaccine uptake for adults aged 70 years (main target group) and adults aged 79 years (catch-up group).
Amongst those eligible for vaccination, 52.4% (n = 18,499) received the vaccine. Socio-demographic factors independently associated with lower zoster vaccine uptake in multivariable analyses were: being older (catch-up group: aged 79 years) aOR = 0.89 (95% confidence interval (CI):0.85-0.93), care home residence (aOR = 0.64 (95%CI: 0.57-0.73)) and living alone (aOR = 0.85 (95%CI: 0.81-0.90)). Uptake decreased with increasing levels of deprivation (p-value for trend<0.0001; aOR most deprived versus least deprived areas = 0.69 (95%CI: 0.64-0.75)). Uptake was also lower amongst those of non-White ethnicities (for example, Black versus White ethnicity: aOR = 0.61 (95%CI: 0.49-0.75)) but was not lower among immigrants after adjusting for ethnicity. Lower uptake was also seen amongst females compared to men in the catch-up group.
Inequalities in zoster vaccine uptake exist in England; with lower uptake among those of non-White ethnicities, and among those living alone, in a care home and in more deprived areas. Tailored interventions to increase uptake in these social groups should assist in realising the aim of mitigating vaccination inequalities. As care home residents are also at higher risk of zoster, improving the uptake of zoster vaccination in this group will also mitigate inequalities in zoster burden.
通过确定带状疱疹疫苗接种与社会人口因素的相关性，量化带状疱疹疫苗接种的不平等现象：年龄、性别、种族、移民身份、贫困程度（在下层地域统计区水平上）、养老院居住情况和居住安排。
本基于人群的队列研究利用了来自英格兰的匿名初级保健电子健康记录（临床实践研究数据链接），并与贫困和住院数据相关联。对来自英格兰 277 家普通诊所的 35333 名符合条件且在疫苗推出后两年内（2013-2015 年）有资格接种带状疱疹疫苗的个体进行了分析。使用逻辑回归获得社会人口因素与 70 岁（主要目标人群）和 79 岁（追赶人群）成年人带状疱疹疫苗接种之间关联的调整后优势比（aOR）。
在符合接种条件的人群中，52.4%（n=18499）接种了疫苗。在多变量分析中，与带状疱疹疫苗接种率较低相关的社会人口因素包括：年龄较大（追赶组：79 岁）aOR=0.89（95%置信区间（CI）：0.85-0.93）、养老院居住（aOR=0.64（95%CI：0.57-0.73））和独居（aOR=0.85（95%CI：0.81-0.90））。随着贫困程度的增加（趋势检验的 p 值<0.0001；最贫困与最不贫困地区相比的 aOR=0.69（95%CI：0.64-0.75）），接种率也会下降。在非白种人群体中，接种率也较低（例如，黑种人比白种人：aOR=0.61（95%CI：0.49-0.75）），但在调整了种族因素后，移民的接种率并没有降低。与追赶组中的男性相比，女性的接种率也较低。
在英格兰，带状疱疹疫苗接种存在不平等现象；非白种人群体、独居者、养老院居住者和贫困地区的接种率较低。针对这些社会群体增加接种率的针对性干预措施应有助于实现减轻疫苗接种不平等的目标。由于养老院居民带状疱疹的风险也较高，因此提高该人群的带状疱疹疫苗接种率也将减轻带状疱疹负担的不平等现象。
